Stop innovating healthcare

Aeon recently published a fantastic piece on innovation, tracing its origins, history, and growth through present day. The central thesis is that innovation culture is overrated, mainly because it overlooks and undervalues work that is less exciting but more important. You may know of some self-described innovators who operate with the tunnel vision of self-justification; whether an innovative approach is effective or efficient or useful does not matter as much as the fact that it’s an innovative approach, so it’s worth trying.

Below are a few excerpts from the Aeon piece that bear consideration for all of us working in the healthcare industry.

Healthcare is in a tumultuous transition phase, and we need to begin reigning in our own innovation culture. We’re heading towards an outcomes-driven future, shaped deeply by both technology and policy. The success of this shift will depend on the next generation of clinical and business leaders; their ability to envision and drive meaningful reforms will depend on a collective self-awareness of what is working and what is not.

Maintenance and repair, the building of infrastructures, the mundane labour that goes into sustaining functioning and efficient infrastructures, simply has more impact on people’s daily lives than the vast majority of technological innovations.

What is the infrastructure of healthcare, and what are we doing to address its needs? Primary care physicians, nurses, social workers, case managers, physician assistants, and other front-line staff do the bulk of the heavy lifting in management of complex populations.

Is the future of outpatient care as bleak as Dr. John Halamka suggests?

The homecare tech of tomorrow has arrived, are today’s nursing homes and rehab hospitals ready?

Public health principles may be more integral to improving healthcare’s infrastructure than shiny new innovations. A popular recent example is the growing role of social determinants of health in the broader conversation around our use of technology, data, and urban planning. These ideas have a long way before they can overcome institutional thinking that prioritizes spending big bucks on R&D and cutting edge technology.

Innovation is only a small piece of what happens with technology. This preoccupation with novelty is unfortunate because it fails to account for technologies in widespread use, and it obscures how many of the things around us are quite old.

Like any other part of the tech sector, health IT’s instinctive tendency is to point to products as progress. In the booming health tech industry, almost any incidental widget or incremental workflow gets branded as an innovation, sent through the hype cycle, and shipped off to market. Vendors are not entirely at fault – they’re simply following the money, whether it’s from Silicon Valley or from Washington DC.

Peeking behind the glimmering curtain of innovation-speak, we need to ask plainly: are new tools and funding streams in healthcare addressing the actual issues of infrastructural maintenance that matter every day?

Medicare’s Chronic Care Management (CCM) program serves as a case study here. A colorful editorial from last fall represents the skeptical clinician’s voice:

Despite claims to the contrary, there is little empirical evidence that CCM services managed by ancillary staff improve quality, patient satisfaction, or primary care use. Patients may not find such services valuable. Collection of more data will not, by itself, ‘coordinate care’ but may fatten the coffers of EHR and care management companies selling EHR add-ons to automate the process.

In 2015 the CCM code was hailed by many as a transformative lever for strengthening primary care. How has that turned out? More importantly – what have we learned? Perhaps it’s time for a thoughtful, honest discussion between CMS and industry about what technology, which companies, and which incentive programs are driving the changes we actually need – and which are not.

There is an urgent need to reckon more squarely and honestly with our machines and ourselves. Ultimately, emphasising maintenance involves moving from buzzwords to values, and from means to ends. In formal economic terms, ‘innovation’ involves the diffusion of new things and practices…contemporary discourse treats innovation as a positive value in itself, when it is not.

None of our failures is more appalling than interoperability. Old news.

At this year’s Health DataPalooza, Vice President Joe Biden earned applause with a speech decrying the state of data silos. Great. So now what?

Adrian Gropper argues that impassioned rhetoric from the top will not be enough to stop vendors from information blocking. Others are questioning if the government has run out of tricks besides throwing moxie and money at the problem.

What do we value more: innovating interoperability or achieving it? We’ve tried the former – new alliances, new standards, new incentive programs. They’ve in turn spawned new startups, new challenge contests, and some new acronyms. But interoperability remains a pipe dream. Perhaps the path forward will require less glamour and glory and more grit and grind: asking tough questions, slapping wrists, and holding vendors accountable.

Innovation-speak worships at the altar of change, but it rarely asks who benefits, to what end? A focus on maintenance provides opportunities to ask questions about what we really want out of technologies. What do we really care about? What kind of society do we want to live in? Will this help get us there?

There’s plenty of old tech that has outstayed its welcome in healthcare – the fax machine is the go-to example, but the patient portal has become a newer one. The joke is that healthcare is 20 years behind the curve; therefore any process that introduces an app, or a new workflow, or a camera, or a sensor, is innovative and therefore important. This is only half-right. Dr. Joe Kvedar from Partners recently commented on the half-steps happening in the world of connected health.

Don’t get me wrong – we should continue to test, pilot, and fail. But responsible, progress-oriented innovation also means learning from our mistakes, applying lessons from one segment of the industry to another, and scaling successes. How many more times do we need to see new remote monitoring studies that plug vendor gizmos into place while ignoring patient workflow?

Industry has gotten into the bad habit of patting itself on the back for issuing press releases featuring “innovative technology” instead of building sustainable, scalable, programs. Telehealth offers a great example of innovation culture gone sideways: On the surface, we see many band-aid tech and service solutions generating steady revenue from large employers.

Deeper down, serious questions fester:

Do we really expect those revenues to keep flowing post-Cadillac tax?

Why aren’t we requiring vendors to build data linkages from virtual visits into the rest of a patient’s records: have we really not learned anything from Meaningful Use?

Will staff at rehab hospitals, nursing homes, and outpatient practices be trained by vendors on how to coordinate care virtually? Or will they have to rely on renting an expensive virtual medical network?

Where is the progressive leadership from the Feds and the Medical societies on reimbursement and intra-state practice laws?
Are these disconnected, piecemeal approaches the best we can do? If not, what does it say about us that we continue to praise them as innovative?

The most important thing in life and business can’t be measured.

This last one is not from the piece, but from a quotation about meaning by John C. Bogle. Take a moment to pause and think about what we want to accomplish in healthcare transformation. Really… take 10 seconds and remember the last time you were a patient or a family member or caring for a patient.

What would you change, if you could?

Now think about what it will take to get there. Does it involve a revolutionary, disruptive, innovative approach or some better training? A plain-English explanation? A tweak in communication policy? More time?

Relentless cheerleading from public and private funders and the disturbing rise of content marketing flashmobs have succeeded in inflating expectations and valuations for new ideas. When we reward innovation for its own sake, we wind up with innovation consultants, innovation conferences, and a self-propagating innovation culture.

To be clear, there is plenty of excellent work going on to integrate technology-driven improvements into the healthcare trenches. And, of course, we need to develop the next generation of tools in artificial intelligence, applied data, 3-D printing, or whatever else.

Disruption needs to be balanced with maintenance to fix our most pressing needs at the population level. Embracing failure shouldn’t preclude aiming for success. Looking forward is important – but so is looking at what’s right under our nose, or to our left and our right.

Perhaps we could all be a bit more judicious in hyping the innovative to avoid overlooking what’s important.

Naveen Rao

Naveen Rao is a healthcare strategist with an eye on how technology, policy, and business are impacting patient care. He runs Patchwise Labs and serves as managing editor @tincturehealth. You can observe him in his natural habitat on twitter @naveen101.

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